Charges of Health Care Fraud

Some Florida residents will be spending the next several years behind bars, thanks to their involvement in a health care scheme that centered around submitting claims for services that were never rendered to patients whose identities were stolen. This country faces a serious challenge in terms of health care fraud, and authorities are not hesitating to impose serious penalties when offenders are caught. It is the most expensive white-collar crime in the country—racking up nearly $100 billion in lost funds—so the feds and the state of Florida are more than willing to prosecute fraudsters.  Both state and federal prosecutors, in fact, are going after individuals and organized groups who engage in this type of fraud on a daily basis.

Examples of Fraud

The Southern District of Florida leads the nation in health care fraud. Fraud in the health care system occurs in many ways and might involve individuals who are recipients of health care, or those who work in hospitals, nursing homes, dentist offices, and more. Attempts to cheat health insurance companies is a major concern because there are so many ways to swindle companies, and because a successful fraudster might sneak away with big bucks. Deliberately providing incorrect or fabricated information to an insurance company is the basis of many fraud cases.  That could mean:

• Double billing insurance companies for a procedure;
• Coding medical procedures in a way that exaggerates billing;
• Charging for procedures and/or care that didn’t occur to increase profits;
• Prescribing unnecessary medications and/or procedures to get kickbacks from pharmaceutical companies.

Legal Penalties 

Offenders in Florida may face misdemeanor or felony charges, depending on the actual type of fraud. Prison time for a number of years—and up to a lifetime–is a definite possibility, as well as thousands in fines. In the case of medical professionals, the loss of professional licensure is likely. Federal penalties are dependent on the degree of injury that occurs to a patient.  Perpetrators could wind up serving 10 years behind bars even if there are no injuries. That sentence doubles when serious injury results from the fraud, and becomes a life sentence if the fraud results in a fatality.

The Federal False Claims Act 

If a person or entity consciously submits a false claim for Medicare, Medicaid, or other federally funded program, or intentionally hangs on to an overpayment for 60 days or more, they are in violation of the federal False Claims Act.  Perpetrators of such fraud may have to pay nearly $22,000 per falsified claim, in addition to having to pay triple the damages suffered by the Government,

Defending Fraud Claims 

One of the best defenses against charges of health care fraud is to demonstrate that any suspected billing irregularities and other discrepancies were simply misunderstandings and/or unintentional blunders. Demonstrating that patients received legitimate care consistent with billing will be important, as will establishing a pattern of providing high-quality care aimed at patient well-being.

An Aggressive Defense 

If you are facing charges of health care fraud, the experienced Kissimmee criminal defense attorneys at Salazar & Kelly Law Group are prepared to put forth a vigorous defense on your behalf. To discuss the particulars of your situation, schedule a confidential consultation in our Kissimmee office today.

Source:

justice.gov/opa/pr/two-florida-residents-sentenced-93m-health-care-fraud-and-money-laundering-scheme